关节和膝关节置换术后的重症监护需要:了解严重的术后并发症的风险概况
Dominik Emanuel Holzapfel1, Tobias Kappenschneider2, Sabrina Holzapfel3
1Department of Orthopaedic Surgery, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany. dominik.holzapfel@ukr.de.
概括
全关节整形术 (TJA) 后的严重不良事件与脆弱性,先前存在的疾病和抗凝剂使用有关. 识别这些风险因素可以帮助防止在关节和膝关节置换后的重症监护室 (ICU) 转移.
科学领域:
- 整形外科手术 整形外科手术
- 临界护理医学 临界护理医学
- 老年医学 老年医学
背景情况:
- 完全关节整形术 (TJA) 后严重危及生命的事件的病因学尚不清楚.
- 在全关节整形术 (THA) 和全膝关节整形术 (TKA) 之后,术后重症监护室 (ICU) 的转移需要进一步调查.
研究的目的:
- 确定术后重症监护的独立预测因子,以THA和TKA为依据.
- 澄清导致TJA后ICU转移的情况.
主要方法:
- 在THA/TKA.之后,对142名克拉维恩-丁多分类IV级 (CD°IV) 事件的患者进行了回顾性队列研究.
- 倾向性得分匹配 (1:1) 与非CD°IV患者的年龄,性别,并发症 (查尔森并发症指数,CCI) 和治疗年.
- 单变量和多变量回归分析以确定独立预测因素.
主要成果:
- CD°IV转移与较高的脆弱性得分 (HFRS),美国麻醉学会 (ASA) 得分,八十岁的比例和医疗并发症相关.
- 对于CD°IVICU转移的独立预测因素包括脆弱性 (OR 1.14),心脏病 (OR 2.0) 和胃肠道 (OR 3.0) 的诊断,以及抗凝剂的使用 (OR 2.7).
结论:
- 经历THA/TKA后CD°IV事件的患者是复杂的,易受伤害的和多病态的.
- 需要采用多学科的方法,整合预康复和术后风险评估.
- 减少需要ICU护理的严重,危及生命的事件是一个关键目标.
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